Construction of performance management system for pharmacy department of tertiary public hospitals under new situation / 中国药房

OBJECTIVE To provide reference for improving the work efficiency of staff and promoting the discipline construction of pharmacy department. METHODS By analyzing the current situation of performance management in the pharmacy department of our hospital， the key successful factors were sorted out， strategic decoding was carried out and key performance indicators were extracted. The quarterly and annual performance appraisal forms were formulated for the departments of pharmacy warehouse， outpatient pharmacy， ward pharmacy， clinical pharmacy department， prescription examination center， laboratory and other departments； the performance management information platform was built. The work efficiency and output of each department were compared half a year before and after the implementation of the performance management plan. RESULTS After the implementation of the program， the average queuing time for drug collection in the outpatient department was shortened from 5 minutes to 3 minutes， the average number of dispensing infusion bags per hour in the pharmacy intravenous admixture services increased from 50 bags to 60 bags， and antibacterial use density of the hospital decreased from 42.7 DDD（defined daily doses） to 40.2 DDD. The number of academic papers published had increased from 8 to 10， and the satisfaction of clinical departments with ward pharmacies increased from 85% to 95%. CONCLUSIONS The performance management system has been successfully established in pharmacy department of our hospital， which can improve the enthusiasm of pharmacists， reflect the value of pharmaceutical care， and promote the discipline construction of pharmacy.

Comparison of Free Flap Outcomes at a University Hospital versus County Hospital Setting for Head and Neck Reconstruction

Abstract Introduction Patients at public county hospitals often have poorer access to healthcare with advanced disease on presentation. These factors, along with limited resources at county hospitals, may have an impact on outcomes for patients requiring complex head and neck reconstruction. Objectives To delineate differences in the frequency of complications in two different care settings, a public county hospital and a private university hospital. Methods Retrospective review of otolaryngology patients at a university hospital compared with a publicly-funded county hospital. The main outcome measure was major complications including total flap loss or unplanned reoperation in 30 days. Secondary outcome measures included medical complications, partial flap loss, and unplanned hospital readmission in 30 days. Results In the county hospital sample (n = 58) free flap failure or reoperation occurred in 20.7% of the patients, and minor complications, in 36.2% of the patients. In the university hospital sample (n = 65) flap failure or reoperation occurred in 9.2% of the patients, and minor complications, in 12.3% of the patients. Patients at the private hospital who had surgery in the oropharynx were least likely to have minor complications. Conclusions Patients at the county hospital had a higher but not statistically significant difference in flap failure and reoperation than those at a university hospital, although the county hospital experienced more minor postoperative complications. This is likely multifactorial, and may be related to poorer access to primary care preoperatively, malnutrition, poorly controlled or undiagnosed medical comorbidities, and differences in hospital resources.

O direito à saúde e o déficit de profissionais de enfermagem nos hospitais públicos: uma análise das decisões do poder judiciário de Rondônia / The right to health and the deficit of nursing professionals in public hospitals: an analysis of the decisions of the judiciary of Rondônia / El derecho a la salud y el déficit de profesionales de enfermería en los hospitales públicos: un análisis de las decisiones del poder judicial de Rondônia

Objetivo: Analisar as decisões exaradas pelo Poder Judiciário de Rondônia, referente aos pedidos de provisão de profissionais de enfermagem para os hospitais públicos, com vistas a identificar qual tem sido a fundamentação predominante na litigância. Métodos: O procedimento adotado foi a análise documental indireta. Procurou-se explorar a análise sob uma abordagem quali-quantitativa. O recorte documental deteve-se na atuação do TRF1 Rondônia, quanto à 26 decisões, referentes a 23 processos judiciais. Resultados: Evidenciou-se que os pedidos de provisão de profissionais de enfermagem foram todos denegados na Seção Judiciária da capital do estado, enquanto foram deferidos nas Subseções do interior. Contudo, para o suprimento de um numerário específico de enfermeiros e/ou técnicos de enfermagem, foi indeferido em todos os juízos do TRF1. Prevaleceu o provimento do pedido de provisão de enfermeiros, fundamentado no princípio da legalidade. Conclusão: Não há um perfil decisório predominante no TRF1, haja vista ser todas as decisões de primeira instância, inexistindo decisões de mérito prolatadas pelo Tribunal em segunda instância. Dessa forma, cada juízo mantém seu próprio tracejado cognitivo jurisdicional, inexistindo uma uniformização para decisões sobre a mesma matéria. Prevaleceu o provimento do pedido de provisão de enfermeiros, fundamentado no princípio da legalidade. (AU)

Objective: To analyze the decisions issued by the Judiciary of Rondônia regarding requests for the provision of nursing professionals to public hospitals, in order to identify the predominant grounds in litigation. Methods: The procedure adopted was indirect documentary analysis. We sought to explore the analysis from a qualitativequantitative approach. The documentary cut focused on the performance of TRF1 Rondônia, regarding 26 decisions related to 23 judicial processes. Results: It was evidenced that requests for the provision of nursing professionals were all denied in the Judicial Section of the state capital, while they were granted in the Subsections of the interior. However, for the supply of a specific number of nurses and/or nursing technicians, it was denied in all the courts of TRF1. The provision of the request for nurses prevailed, based on the principle of legality. Conclusion: There is no predominant decision-making profile in TRF1, since all decisions are at the first instance, with no merit decisions made by the Court at the second instance. Thus, each judge maintains their own jurisdictional cognitive tracing, without there being a uniformity for decisions on the same subject. The provision of the request for nurses prevailed, based on the principle of legality. (AU)

Objetivo: Analizar las decisiones emitidas por el Poder Judicial de Rondônia, relativas a las solicitudes de provisión de profesionales de enfermería para los hospitales públicos, con el fin de identificar cuál ha sido la fundamentación predominante en la litigación. Métodos: El procedimiento adoptado fue el análisis documental indirecto. Se buscó explorar el análisis desde un enfoque cualitativo-cuantitativo. El recorte documental se centró en la actuación del TRF1 Rondônia, en relación con 26 decisiones relativas a 23 procesos judiciales. Resultados: Se evidenció que todas las solicitudes de provisión de profesionales de enfermería fueron denegadas en la Sección Judicial de la capital del estado, mientras que fueron concedidas en las Subsecciones del interior. Sin embargo, para el suministro de un número específico de enfermeros y/o técnicos de enfermería, se denegó en todos los juzgados del TRF1. Prevaleció la provisión de la solicitud de enfermeros, fundamentada en el principio de legalidad. Conclusión: No hay un perfil decisivo predominante en el TRF1, ya que todas las decisiones son de primera instancia, no existiendo decisiones de mérito pronunciadas por el Tribunal en segunda instancia. De esta manera, cada juez mantiene su propio trazado cognitivo jurisdiccional, sin haber una uniformidad para las decisiones sobre la misma materia. Prevaleció la provisión de la solicitud de enfermeros, fundamentada en el principio de legalidad. (AU)

Transparência, accountability e governance: revisão sistemática da literatura nos hospitais públicos / Transparencia, rendición de cuentas y gobernanza: una revisión de la literatura en el contexto de los hospitales públicos / Transparency, accountability, and governance: a literature review in the context of public hospitals

Resumo Neste estudo busca-se desenvolver uma revisão da literatura baseada na análise bibliométrica sobre o tema da transparência e da accountability no contexto da governance dos hospitais públicos, procurando identificar linhas de investigação, teoria, método de investigação e lacunas existentes por intermédio da análise das publicações científicas datadas até 2020. A investigação seguiu o referencial teórico da transparência e da accountability no setor público com o intuito de compreender o seu enquadramento no contexto da governance dos hospitais. Com recurso ao software Bibliometrix e terminado o processo de consulta dos artigos nas bases de dados Scopus e WoS, foram selecionados 118 artigos para este estudo. Constatou-se que, no período entre 2017-2020, cerca de 85% das publicações são de base qualitativa e há uma tendência crescente no estudo da transparência e da accountability na governança dos hospitais públicos. A transparência surge frequentemente interligada à responsabilização dos agentes (accountability), às políticas de comunicação externa (relatórios públicos) e interna, assim como à sua compreensibilidade. Verificou-se a ainda predominância das publicações de origem norte-americana e chinesa. O estudo identifica também a escassez de investigação baseada em modelos quantitativos que explorem relações de dependência entre as dimensões estudadas, limitando a compreensão da interdependência entre as práticas de transparência e os atributos internos e externos das organizações. O estudo contribui para o conhecimento sobre interações entre transparência, accountability e prestação de contas na governança dos hospitais públicos.

Resumen El objetivo de este estudio es desarrollar una revisión bibliográfica basada en el análisis bibliométrico sobre el tema de la transparencia y la rendición de cuentas en el ámbito de la gobernanza de los hospitales públicos, buscando identificar líneas de investigación, teorías, métodos de investigación y lagunas existentes a través del análisis de las publicaciones científicas fechadas hasta 2020. La investigación siguió el referencial teórico de la transparencia y la rendición de cuentas en el sector público para comprender su marco en el ámbito de la gobernanza de los hospitales. Recurriendo al software Bibliometrix, y tras el proceso de consulta de los artículos en las bases de datos Scopus y WoS, se seleccionaron 118 artículos de interés para este estudio. Se constató que, en el periodo comprendido entre 2017 y 2020, aproximadamente el 85% de las publicaciones son de base cualitativa y existe una tendencia creciente en el estudio de la transparencia y la rendición de cuentas en el ámbito de la gobernanza de los hospitales públicos. La transparencia aparece a menudo interconectada con la responsabilidad de los agentes (rendición de cuentas), las políticas de comunicación externa (informes públicos) e interna, así como su comprensibilidad. También se observó el predominio de publicaciones de origen norteamericano y chino. El estudio también identifica la escasez de investigaciones que utilicen modelos cuantitativos que exploren las relaciones de dependencia entre las dimensiones estudiadas, lo que limita la comprensión de la interdependencia entre las prácticas de transparencia y los atributos internos y externos de las organizaciones. El estudio contribuye al conocimiento de las interacciones entre transparencia, rendición de cuentas y reporte en el ámbito de la gobernanza de los hospitales públicos.

Abstract This study develops a literature review based on bibliometric analysis on the theme of transparency and accountability within the scope of governance of public hospitals, seeking to identify research lines, theories, research methods, and existing gaps through the analysis of scientific publications until 2020. The investigation followed the theoretical lens of transparency and accountability in the public sector to understand its framework within the scope of the governance of hospitals. Using the Bibliometrix software, and after the consultation process of the articles published in the Scopus and WoS databases, a sample with 118 articles was selected. It was found that, in the period between 2017-2020, approximately 85% of the publications were qualitative, and there is a growing trend in the study of transparency and accountability within the scope of governance of public hospitals. Transparency often appears interconnected with the accountability of agents (accountability), external communication policies (public reports), internal communication policies, and their comprehensibility. The predominance of publications of North American and Chinese origin was also noted. The study also identifies the scarcity of research using quantitative models that explore dependency relationships between the dimensions studied, limiting the comprehensibility of the interdependence between transparency practices and organizations' internal and external attributes. The study contributes to the knowledge about the interactions between transparency, accountability, and reporting within the scope of governance of public hospitals.

Uso da classificação de robson para avaliação das taxas de cesáreas em hospitais paranaenses vinculados ao sistema único de saúde / Use of the robson classification for the evaluation of cesarean section rates in hospitals in the state of paraná linked to the single health system / Uso de la clasificación de robson para evaluar las tasas de cesrea en hospitales paranaeses vinculados al sistema de salud único

Introdução: Os índices de parto cesariano vêm aumentando mundialmente e ultrapassando, em muitos locais, os índices de parto vaginal. No entanto, tais índices nem sempre refletem a indicação real do procedimento. Objetivo: analisar as taxas de cesáreas de hospitais vinculados à Secretaria Municipal do Estado do Paraná no ano de 2021, exceto universitários, através da Classificação de Robson. Métodos: Trata-se de um estudo descritivo, transversal e de abordagem quantitativa, foram avaliadas 356 instituições de saúde do estado do Paraná, os dados foram coletados no site do Departamento de Informática do Sistema Único de Saúde (DATASUS), através do Sistema de Informações sobre Nascidos Vivos (SINASC) via tabulador oficial do Ministério da Saúde- Tabwim, no ano de 2021. Resultados: Os maiores índices segundo Classificação de Robson, foram de mulheres entre 20 à 34 anos, com companheiro, escolaridade de oito anos ou mais de estudo, multíparas com filhos vivos anteriores a última gestação, sendo estas a termo, com gravidez única e sem anomalias congênitas, além da realização de sete consultas de pré-natal com seu início no primeiro trimestre de gestação. Conclusão: o parto cesariano ultrapassa os índices do parto vaginal. Podemos evidenciar a importância que os profissionais de saúde possuem para revertermos essa realidade através da educação em saúde, e no desenvolvimento de estratégias que minimizem esses números expressivos de cesarianas.

Introduction: The rate of cesarean delivery has been increasing worldwide and in many places surpassing the rate of vaginal delivery. However, such indexes do not always reflect the actual indication of the procedure. Objective: To analyze the rates of cesarean sections of hospitals linked to the Municipal Secretariat of the State of Paraná in the year 2021, except university, through the Robson Classification. Methods: It is a descriptive, cross-sectional and quantitative approach study, 356 health institutions of the state of Paraná were evaluated, the data were collected on the website of the Department of Informatics of the Unified Health System (DATASUS), through the Information System on Live Births (SINASC) via the official tabler of the Ministry of Health- Tabwim, in the year 2021. Results: The highest rates according to the Robson Classification were women between 20 and 34 years of age, with a partner, eight years of schooling or more of study, multiparous with living children prior to the last pregnancy, these being full-term, with single pregnancy and without congenital anomalies, in addition to having seven prenatal appointments with their start in the first trimester of gestation. Conclusion: cesarean delivery exceeds the rates of vaginal delivery. We can highlight the importance that health professionals have to reverse this reality through health education, and in the development of strategies that minimize these expressive numbers of cesareans.

Introducción: las tasas de natalidad cesárea han estado aumentando en todo el mundo y han superado las tasas de natalidad vaginal en muchos lugares. Sin embargo, esos índices no siempre reflejan la indicación real del procedimiento. Objetivo: analizar las tasas de cesárea hospitalaria vinculada a la Secretaría Municipal del Estado de Paraná en 2021, excepto los graduados universitarios, a través de la Clasificación de Robson. Métodos: Se trata de un estudio descriptivo, transversal y cuantitativo; se evaluaron 356 instituciones de salud del estado de Paraná; los datos se recogieron en el sitio web del Departamento de Información del Sistema de Salud Pública (DATASUS), a través del Sistema de Información sobre Aves Vivas (SINASC) a través del tabulador oficial del Ministerio de Salud ­ Tabwim, en 2021. Resultados: Los índices más altos según la Clasificación de Robson fueron las mujeres de 20 a 34 años de edad, con parejas, escolaridad durante ocho años o más de estudio, multiples con hijos vivos antes del último embarazo, con un solo embarazo y sin anomalías congénitas, y también se realizaron siete consultas prenatales con su inicio en el primer trimestre de gestación. Conclusión: el parto cesárea excede las tasas vaginales de nacimiento. Podemos destacar la importancia que tienen los profesionales de la salud para revertir esta realidad a través de la educación sanitaria, y en el desarrollo de estrategias que minimicen este número expresivo de cesáreas.

Intervenciones de terapia ocupacional con personas mayores en procesos finales de vida en hospitales públicos / Intervenções de terapia ocupacional com pessoas idosas em processos de fim de vida em hospitais públicos / Occupational therapy interventions with elderly people at the end-of-life processes in public hospitals

Resumen Introducción La intervención de terapia ocupacional con personas mayores en procesos de fin de vida en contextos hospitalarios presenta escasa documentación científica en Chile. Dado el aumento de la población mayor, la alta prevalencia de enfermedades crónicas en ella y las tasas de mortalidad hospitalaria, se identifica la necesidad de revisar las intervenciones que se realizan en los procesos de fin de vida de las personas mayores. Objetivo Caracterizar intervenciones de terapia ocupacional con personas mayores que cursan su proceso de fin de vida, desde la percepción de terapeutas ocupacionales dedicados/as al área, en contextos hospitalarios públicos de Chile. Método La investigación es de tipo cualitativa enmarcada dentro del paradigma constructivista bajo el enfoque fenomenológico, utilizando como técnica de recolección de información la entrevista semiestructurada y posterior análisis de contenido. La muestra de estudio está compuesta por terapeutas ocupacionales que ejercen su labor en hospitales públicos del país. Resultados Se identifica a terapeutas ocupacionales como agentes que otorgan cuidados humanizantes y acompañamiento durante las intervenciones en procesos de fin de vida, y a las familias como un facilitador del mismo. Se releva una visión integral de la persona en estos procesos. Conclusiones Existe consenso en el enfoque e intervenciones de terapia ocupacional identificadas por las/os participantes, y resulta similar a lo descrito en la literatura internacional. Faltan lineamientos de política pública local que permitan definir de mejor manera el rol profesional en este contexto.

Resumo Introdução A intervenção da terapia ocupacional com idosos nos processos de fim de vida em contextos hospitalares apresenta pouca documentação científica no Chile. Diante do aumento da população idosa, da alta prevalência de doenças crônicas nesta população e das taxas de mortalidade hospitalar, identifica-se a necessidade de rever as intervenções realizadas nos processos de fim de vida do idoso. Objetivo Caracterizar as intervenções de terapia ocupacional com idosos em processo de fim de vida, a partir da percepção de terapeutas ocupacionais da área, em contextos hospitalares públicos no Chile. Método A pesquisa é do tipo qualitativo na perspectiva do paradigma construtivista sob a abordagem fenomenológica, utilizando-se de entrevista semiestruturada como técnica de coleta de informações e posterior análise de conteúdo. A amostra do estudo é composta por terapeutas ocupacionais que atuam em hospitais públicos no Chile. Resultados Os terapeutas ocupacionais são identificados como agentes que prestam atendimento humanizado e apoio durante as intervenções nos processos de fim de vida, e à família, principalmente como facilitadora deste processo. Nesses momentos, revela-se uma visão integral da pessoa. Conclusões Há consenso sobre a abordagem e intervenções da terapia ocupacional identificadas pelos participantes, sendo semelhante ao descrito na literatura estrangeira. Faltam diretrizes de políticas públicas locais que permitam uma melhor definição do papel do profissional nesse contexto.

Abstract Introduction The intervention of occupational therapy with elderly people in end-of-life processes in hospital contexts presents short scientific documentation in Chile. Given the increase in the elderly population, their high prevalence of chronic diseases, and the hospital mortality rates, the need to review the interventions carried out in the end-of-life processes of the elderly are identified. Objective To characterize occupational therapy interventions with elderly people who are in their end-of-life process, from the perception of occupational therapists dedicated to the area, in public hospital contexts in Chile. Method The research is of a qualitative type framed within the constructivist paradigm under the phenomenological approach, using the semi-structured interview as an information collection technique and subsequent content analysis. The study sample is made up of occupational therapists who work in public hospitals in the country. Results Occupational therapists are identified as agents that provide humanizing care and support during interventions in end-of-life processes, and families mainly as a facilitator of the same. In these processes, an integral vision of the person is revealed. Conclusions There is consensus on the occupational therapy approach and interventions identified by the participants, and it is similar to what is described in the international literature. There is a lack of local public policy guidelines that allow a better definition of the professional role in this context.

Practice of Cultivating Humanistic Literacy in Public Hospitals Based on Patient Experience Improvement / 中国医学伦理学

Patient experience is an important window for modern hospital management and medical service quality, and also an important point for humanistic hospital construction. Improving patient experience is of great significance for constructing harmonious doctor-patient relationship and improving patients’ satisfaction and sense of gain. Based on the perspective of patient experience improvement, this paper analyzed the core value of "patient demand first" of Mayo Clinic and the operational experience of Cleveland Medical Center Patient Experience Office, and applied them to the cultivation of humanistic hospital culture in the First Affiliated Hospital of Xi’an Jiaotong University. Based on the concept of "strengthening patient demand orientation", with the goal of "building a high-quality patient service system and significantly improving patient satisfaction", through building education platforms for medical ethics and medical humanism, exploring the medical humanism dissemination mode for medical staff, and carrying out the humanism literacy cultivation practice in the training camp for improving hospital service efficiency, the humanistic cultural atmosphere of the hospital has been further enhanced, and the patient satisfaction has been steadily improved. It provides reference for the cultivation of humanistic literacy and the construction of new culture in public hospitals in the context of high-quality development.

Cognitive Analysis and Countermeasures of Medical Humanistic Service Ability Based on the Perspective of Medical Staff in Public Hospitals / 中国医学伦理学

【Objective:】 To explore the cognition of medical staff in public hospitals regarding the medical humanistic service ability, and to discuss, analyze, and put forward targeted suggestions based on statistical data. 【Methods:】 A self-designed questionnaire survey was conducted among 825 medical staff randomly selected from public medical institutions in Nanjing, Central, Northern and Southern Jiangsu Province. SPSS21.0 was used to analyze the data. 【Results:】 The average score of medical staff’s familiarity with medical humanities was 3.64 points. In the cognition of the components of medical humanistic service ability, the doctor-patient communication ability accounted for the highest proportion (90.82%). There were differences in the cognition of medical staff with different demographic characteristics on the dimensions of appearance and behavior ability, doctor-patient communication ability, and patient care ability (P<0.05). The surgeon’s cognition of the importance of medical humanities was lower than that of the other four departments (P<0.05). 【Conclusion:】 Medical staff needed to improve their medical humanistic service abilities, and the cognition of humanistic differences among different categories of personnel needed to be adjusted. Public hospitals were suggested to clarify the evaluation elements and standards of medical humanistic services, and focus on solving cognitive differences to improve medical humanistic service abilities, speeding up the construction of humanistic hospitals, promoting medical humanistic service abilities. In addition, it was also necessary to improve the quality of medical humanistic education in colleges and universities through ideological and political courses.

From innovation to intrapreneurship: The new strategy of public hospital to promote medical technology transfer / 中华医学科研管理杂志

Objective:To analyze the practice of technology transfer and innovation in public hospitals base on intrapreneurship perspective, explain the foundation of intrapreneurship and put forward the frame for measuring the intrapreneurship practice.Methods:Induction method was introduced to summarize the bottleneck in technology transfer and innovation and the basis of intrapreneurship in public hospitals. Documentary study was introduced to summarize the definition of intrapreneurship in public hospitals context, the difference among related definitions were compared and a frame for measurement was preliminarily established.Results:The Constraints for public hospitals in technology transfer and innovation are the restriction from patents and papers to primary products and the restriction in hospital management. Thereupon, traditional innovation theory couldn not explain the future development of public hospitals. The evolution from innovation to intrapreneurship is deeply needed. Extended services, development of technology, upgrade of process and organized research could be employed to measure the intrapreneurship of public hospitals.Conclusions:As active innovators, not passive recipient, physicians can utilize resources of hospitals to minimize risk of innovation to enhance capability against inner and outer change. Intrapreneurship can be employed to explain this kind of practice. Innovation is based on creation of knowledge and technology, Intrapreneurship on the other hand is featured creating value for organization and personnel. Intrapreneurship is different from innovation theoretically. The research on intrapreneurship would enrich the understanding of high-quality development of public hospital. Intrapreneurship is the evolution of public hospitals in the chain of technology transfer.

Research on the implementation path of empowerment of scientific and technological achievements of researchers in public hospitals / 中华医学科研管理杂志

Objective:To explore the implementation path of scientific and technological achievement empowerment for researchers in public hospitals.Methods:Through literature research, theoretical research, policy research, etc, current situation and progress of the ownership management reform of scientific and technological achievements at home and abroad were sorted out, and the difficult problems in the empowerment of scientific and technological achievements were summarized in combination with its practice in domestic public hospitals.Results:The following problems existed in the empowerment of scientific and technological achievements in public hospitals: weak awareness of medical staff′s ownership protection imperfect empowerment system, lagging construction of management personnel, and constraints of state-owned assets management.Conclusions:It is suggested to improve the coordination mechanism of government departments, optimize related policy and law environment and innovation atmosphere, implement a categorized and tiered empowerment strategy for job scientific and technological achievements, set up a management platform of medical scientific and technological achievements, build a complete support service system, establish a mechanism for cultivating and producing high-value achievements, and strengthen the construction of achievement management personnel.

Organizações Sociais de Saúde na mídia: uma análise de notícias em grandes veículos de imprensa (2008-2016) / The Social Health Organizations in the media: analysis of news in large press outlets (2008-2016) / Las Organizaciones Sociales de Salud en los medios: un análisis de las noticias en los principales medios de comunicación (2008-2016)

Este estudo analisou matérias jornalísticas sobre Organizações Sociais de Saúde (OSS) contratadas para gerir hospitais estaduais no Brasil. Foram levantadas publicações nos meios de comunicação G1, Estadão e Valor Econômico sobre as dez maiores OSS do país. Analisou-se o conteúdo de 124 matérias, sendo a maioria da organização Associação Paulista para o Desenvolvimento da Medicina (SPDM), entre os temas: denúncia de irregularidades, desvio de verbas, metas subestimadas, falta de licitações e precarização do trabalho. Houve também conteúdos sobre flexibilidade, dinamismo gerencial, agilidade nas contratações e economia aos cofres públicos. Os achados apontaram para elementos que visam tanto ao fortalecimento do modelo de gestão reforçado pela Nova Gestão Pública (NGP) quanto à mobilização da sociedade frente a essas instituições privadas.

This study analyzed news stories about Social Health Organizations contracted to manage state hospitals in Brazil. We selected publications from G1, Estadão and Valor Econômico media about the ten largest Brazil-ian Social Health Organizations. We analyzed the content of a total of 124 articles, most of them from the Associação Paulista para o Desenvolvimento da Medicina (SPDM) organization, denouncing irregularities, misuse of funds, underestimated goals, lack of tenders and precarious work. There were articles also about flexibility, managerial dynamism, agility in hiring and savings to public coffers. The findings pointed to an outline aimed both at strengthening the management model reinforced by the New Public Management, and at mobilizing society towards these private institutions.

Este estudio analizó artículos sobre Organizaciones Sociales de Salud (OSS) contratadas para administrar hospitales estatales en Brasil. Se levantaron publicaciones en los medios G1, Estadão y Valor Econômico sobre las diez mayores OSS del país. Se analizó el contenido de 124 artículos, la mayoría de la organización Associação Paulista para o Desenvolvimento da Medicina (SPDM), de denuncia de irregularidades, malversación de fondos, subestimación de metas, falta de licitaciones y precariedad laboral. También tuvo contenidos sobre flexibilidad, dinamismo gerencial, agilidad en la contratación y ahorro para las arcas públicas. Los hallazgos apuntaron elementos dirigidos tanto al fortalecimiento del modelo de gestión reforzado por la Nueva Gestión Pública, como a la movilización de la sociedad hacia estas instituciones privadas.

Mortalidade por Covid-19 em hospitais públicos e privados de Florianópolis/SC / Covid-19 mortality in public and private hospitals of Florianópolis/SC

Introdução: O acesso ao tratamento hospitalar adequado é importante para amenizar o impacto causado pelas questões socioeconômicas, auxiliando no combate às iniquidades em saúde. Objetivo: Analisar a diferença da atenção hospitalar pública e privada na mortalidade por Covid-19 em Florianópolis/SC. Métodos: Coorte histórica com dados de pacientes confirmados para Covid-19 entre 22 de fevereiro de 2020 e 09 de novembro de 2020. Utilizou-se abordagem de dupla-robustez. Na primeira etapa, parearam-se indivíduos notificados em hospitais públicos e privados por algoritmo genético. A seguir, estimou-se a probabilidade de óbito em hospitais públicos e privados, por meio de regressão logística. Analisou-se, então, a diferença entre as densidades de probabilidade de óbito dos dois tipos hospitalares. Resultados: Analisaram-se 2.497 pessoas, 1.244 de hospitais públicos e 1.253 de privados. A diferença entre a probabilidade condicional de óbito assumindo que todos os pacientes fossem notificados em hospitais públicos ou que todos fossem notificados em hospitais privados foi de -0,0002 (IC 95% -0,0013; 0,0005). Conclusão: A probabilidade de óbito por Covid-19 mostrou-se semelhante entre pacientes de hospitais públicos e privados.

Introduction: Access to adequate hospital treatment is important to alleviate the impact of socioeconomic issues, helping in the fight against health inequities. Objective: To analyze differences between public and private hospital care regarding COVID-19 mortality in Florianópolis/SC. Methods: This is a historical cohort study with data from patients who had a COVID-19 diagnosis confirmed between February 22, 2020 and November 9, 2020. We used a doubly robust approach. In the first stage, we paired individuals reported by public and private hospitals through a genetics algorithm. Subsequently, we estimated the probability of death in public and private hospitals using a logistic regression. We then analyzed the difference between probability densities of death in both hospital types. Results: This study analyzed 2,497 people, 1,244 public hospitals, and 1,253 private institutions. The difference between conditional probabilities of death assuming that all patients were reported by public hospitals or that all of them were reported by private hospitals was -0.0002 (95%CI -0.0013; 0.0005). Conclusion: The probability of death due to COVID-19 was shown to be similar between patients of public or private hospitals.

The neonatal transfer process through the lens of neonatologists at public hospitals in South Africa

Background: Neonatal care is provided by various levels of healthcare facilities in South Africa. Intensive care for neonates is only provided at the higher levels, hence the need for transfers from lower-level to higher-level facilities (e.g. primary hospitals to tertiary hospitals) or across levels of facilities, particularly when life-threatening situations arise (e.g. cardiac deterioration, respiratory deterioration and desaturation). Aim: The aim of the study was to explore neonatologists' views regarding the neonatal transfer process and to describe the preparedness of advanced life support (ALS) paramedics to undertake such transfers. Setting: The setting consisted of neonatologists from three provinces i.e. KwaZulu-Natal, Gauteng and Western cape. Method: A qualitative descriptive design was utilised in this study. Semistructured interviews were conducted on the public health hospitals in three provinces (N = 9; n = 3) with neonatologists (N = 7; n = 7) who were involved in the transfers of critically ill neonates. The process of thematic analysis was used. Results: The themes that emerged in this study were: an awareness of local contextual realities related to neonatal transfers, challenges evident within the context of neonatal transfers, decision-making around the transfer of ill neonates, ALS paramedic preparedness for transfers and good clinical governance Conclusion: The study found that there was a need to be aware of local contextual realities confronting neonatal transfers, a need for greater preparedness for paramedics to undertake these transfers, a need for a sound referral processes and a need for coordinated transfer effort between paramedics, hospital staff and transport team members for the successful transfer of critically ill neonates. Contribution: The findings highlight the challenges confronting the neonatal transfer process in South Africa through the lens of neonatologist at public hospitals. Hence, the study reinforces the preparedness and coordination of the transfer process, along with more efficient communication between paramedics, hospital staff and the transfer team.

Status survey on pediatric emergency in secondary and tertiary public hospitals in Shanghai city / 中国小儿急救医学

Objective:To understand the current situations and existing problems of pediatric emergency in Shanghai city and provide a basis for the construction and management of pediatric emergency.Methods:The questionnaire survey was used to investigate the current situations of pediatric emergency department in secondary and tertiary public hospitals in Shanghai city.Results:A total of 28 questionnaires were delivered, and 28 were responded.Six of the 28 hospitals had no administratively independent pediatric emergency or no separate pediatric emergency area.Of the 22 hospitals, each had an average of 9.7 professional emergency pediatricians, with the exception of one secondary hospital that lacked professional emergency pediatricians.Professional emergency pediatricians accounted for an average of 70.0% of all pediatricians.Of the 22 hospitals, 18(81.8%) were open 24 hours a day.Fourteen(63.6%) had independent triage.Eight children′s emergency rooms(36.4%) were shared with adults.Among the 22 hospitals, 20 hospitals filled in the annual total number of pediatric emergency visits, and the total number of pediatric emergency visits ranged from 2 791 to 467 428, with an average of 93 966.65.Conclusion:There are still some problems in the development of pediatric emergency department in secondary and tertiary public hospitals in Shanghai city, such as insufficient human resources, substandard personnel training, incomplete equipment and lack of critical first-aid techniques.Therefore, the construction and management of pediatric emergency department still need to be improved.

The effect of national tertiary public hospital performance assessment on the functional orientation of provincial public hospitals / 中华医院管理杂志

Objective:To analyze the impact of the national tertiary public hospital performance assessment(hereinafter referred to as the national examination) on the functional orientation of the provincial public hospitals in Zhejiang province, for reference to improve the allocation of provincial medical resources and high-quality development of public hospitals.Methods:The data came from the hospital financial data of 17 provincial tertiary public hospitals in Zhejiang province from 2012 to 2021 and the DRG quality performance analysis report of the tertiary hospitals in Zhejiang province from 2020 to 2021. The information of the number of employees and actual number of beds at the end of the period, etc., were extracted to analyze the overall operation of the hospital. The ratio of outpatient times to discharged times and the proportion of discharged patients undergoing surgery, as well as the proportion of discharged patients′ day surgery and level-4 surgery in hospital and in province were took as evaluation indicators to analyze the functional positioning of tertiary public hospitals.Results:Compared with 2012 to 2018, the average number of employees at the end of the period and actual number of beds in 17 hospitals from 2019 to 2021 increased by 761 and 303 respectively, and the average number of hospitalization days decreased by 2.26 days. The average ratio of outpatient times to discharged times in the hospital decreased from 175.76 in 2012 to 67.51 in 2021. The average proportion of discharged patients undergoing surgery in general hospitals increased from 0.39 in 2012 to 0.46 in 2021, and that in non-general hospitals decreased from 0.67 to 0.43. The average proportion of discharged patients undergoing day surgery in hospital and in province increased from 0.20 and 0.03 in 2020 to 0.23 and 0.04 in 2021 respectively, and the average proportion of discharged patients undergoing level-4 surgery in province increased from 0.04 to 0.05.Conclusions:The national examination could be conducive to strengthening the functional orientation of public hospitals. After the national examination, the ratio of outpatient times to discharged times in the provincial tertiary public hospitals in Zhejiang province had declined as a whole, the proportion of discharged patients in general hospitals had increased, but the proportion of level-4 surgery in hospitals needs to be further improved. The author suggested that we should continue to strengthen the operation mechanism of functional positioning of provincial public hospitals, improve the service capacity of hospitals for difficult and critical diseases, and improve the performance evaluation system of tertiary public hospitals.

Performance appraisal of the business operation of a public hospital based on entropy weighted TOPSIS method / 中华医院管理杂志

Objective:To evaluate the business performance of an urban public tertiary hospital in Jiangsu province since the comprehensive reform of urban public hospitals started from the end of 2015, for reference in developing relevant policies.Methods:Such level-1 indicators as risk management ability, asset operation ability, revenue and expenditure structure management, asset profitability and future development ability were selected based on literature review, along with 14 level-2 indicators, to build an operation performance appraisal indicator system for urban public hospitals. The entropy weight TOPSIS method was used to evaluate the business performance of an urban public hospital in Jiangsu province from 2015 to 2019.Results:The drugs proportion(a level-2 indicator) under the revenue and expenditure structure management, the growth rate of fixed assets(a level-2 indicator) under the future development ability, and the total return(a level-2 indicator) under the asset profitability, were important ones affecting the business performance of hospitals, with the weights of 0.099, 0.097 and 0.080 respectively. The business operation performance ranking as calculated by the relative closeness, was 2015(0.515), 2016(0.480), 2019(0.467), 2018(0.450) and 2017(0.356) respectively.Conclusions:The reform once resulted in fluctuations in the operation performance of this hospital, with constant declines from 2015 to 2017. With the deepening reform, its performance recovered after 2018 to some extent. It is suggested to improve the business operation performance of urban public hospitals by optimizing their income and expenditure structure, improving their asset operation ability, and matching rationally their asset liability structure, among other measures.

Interpretation and thinking of indicators of pharmaceutical administration in National Tertiary Public Hospitals Performance Evaluation Operational Manual （2022 edition） / 中国药房

OBJECTIVE To interpret the revision of the in dicators o f pharmaceutical administration in National Tertiary Public Hospitals Performance Evaluation Operational Manual （2022 edition）[hereinafter referred to as the Mannual（2022 edition）]，and to provide reference for the implementation of a new round of performance appraisal in tertiary public hospitals. METHODS The contents and revision details of the indicators of pharmaceutical administration in the Mannual（2022 edition）were described briefly，and the revised contents were interpreted and relevant suggestions were put forward. RESULTS & CONCLUSIONS The Manual（2022 edition）continued the scope of performance evaluation ，indicators’structure and sequence in the Manual（2020 edition），which focused on rational drug use and drug cost control. The Manual （2022 edition） placed more emphasis on strengthening the provision and use of essential medicines and selected drugs in the centralized drug procurement ，and further reducing the burden of medical costs in patients. It is suggested that tertiary public hospitals scientifically set indicators for the use of essential medicines ，selected drugs in the centralized drug procurement ，auxiliary drugs and antibacterial drugs in clinical departments，and improve relevant incentive mechanisms and performance assessment systems ；strengthen the interpretation of policies about essential medicines and drug centralized procurement ，as well as the training of rational drug use ；optimize in-hospital drug catalog and formulary ；formulate medication standards ，strengthen prescription review ，rational medication review and assessment ；establish and improve the drug use monitoring and evaluation and early warning system so as to standardize clinical drug use behavior by information technology ；strengthen the use of essential drugs and centrally purchase selected drugs on the basis of ensuring rationality ；control the unreasonable gradually reduce the increase in average drug costs.

Experiencias de fonoaudiólogos/as en hospitales y Centros Comunitarios de Rehabilitación: ¿se modifica la práctica de atención? / Experiences of speech therapist in hospitals and Community Rehabilitation Centers: is the care practice changed?

El presente trabajo busca caracterizar las prácticas fonoaudiológicas en dos contextos de atención de la salud pública chilena (hospitalario y atención primaria -centros comunitarios de rehabilitación). Es un estudio cualitativo con enfoque micro-sociológico, que implicó la realización de entrevistas en profundidad y observaciones no participantes a dos fonoaudiólogos/as insertos en Centros Comunitarios de Rehabilitación (CCR) y dos fonoaudiólogos/as insertos en hospitales públicos. Los datos obtenidos se analizaron con herramientas de la Teoría Fundamentada y se propuso una conceptualización basada en semejanzas y diferencias de las prácticas fonoaudiológicas utilizando el software computacional ATLAS-ti. Del análisis surgen las siguientes categorías: rol del profesional, sujeto de atención, relación terapeuta-usuario/a, espacio físico y organización de la sesión, los/las participantes. Además, el principal hallazgo refiere a que todos/as los/las profesionales mencionan la relevancia de incorporar matices psicosociales en el abordaje que realizan. Sin embargo, en la práctica de todos/as los/las fonoaudiólogos/as durante la observación participante no se evidencia dicha incorporación. Los resultados permiten concluir que la conceptualización del quehacer fonoaudiológico se construye mayormente a partir del contexto laboral. Asimismo, los modelos de atención a la base (biomédico-biopsicosocial) se encuentran actualmente en un proceso de hibridación, siendo la práctica de los/las fonoaudiólogos/as situada y también influida por el contexto laboral.

The present work seeks to characterize speech therapy practices in two Chilean public health care contexts (hospital and primary care -community rehabilitation centers). It is a qualitative study with a micro-sociological approach, which involved conducting in-depth interviews and non-participant observations with two speech therapists inserted in Community Rehabilitation Centers (CCR) and two speech therapists enrolled in public hospitals. The data obtained were analyzed with Grounded Theory tools and a conceptualization based on similarities and differences of speech therapy practices was proposed using ATLAS-ti computational software. The following categories emerge from the analysis: role of the professional, subject of care, therapist-user relationship, physical space and organization of the session, the participants. In addition, the main finding refers to the fact that all the professionals mention the relevance of incorporating psychosocial nuances in the approach they carry out. However, in the practice of all speech therapists during participant observation, such incorporation is not evidenced. The results allow us to conclude that the conceptualization of speech therapy is built mostly from the work context. Likewise, the models of care at the base (biomedical-biopsychosocial) are currently in a process of hybridization, the practice of speech therapists being situated and also influenced by the work context.

Características del embarazo y nacimiento en el Noreste de México y correlación con la evaluación neurológica del recién nacido / Pregnancy and delivery characteristics in northeastern Mexico and their correlation with neonatal neurological evaluation

Resumen OBJETIVO: Determinar las características del embarazo y nacimiento en hospitales públicos del estado de Nuevo León y analizar los resultados de la valoración neurológica de los recién nacidos. MATERIALES Y MÉTODOS: Estudio de serie de casos, ambispectivo, multicéntrico, aleatorizado y transversal efectuado del 2017 al 2020 en tres hospitales públicos de Nuevo León, México. La muestra se reclutó de madres en puerperio seleccionadas en forma aleatoria y recién nacidos con la valoración Neo Neuro and Up de Sheridan Perreira. RESULTADOS: De 75,951 madres en puerperio inmediato, asignadas al azar, se estudiaron 4241. El 87.2% eran residentes de Nuevo León y 12.7% de otros estados del Noreste de México. El 39.9% tuvieron control prenatal en los hospitales de nacimiento de sus hijos. El 51.0% nacieron por parto eutócico y 27.4% por cesárea programada. El 9.6% de los recién nacidos fueron pretérmino. Las características pre y perinatales más frecuentes fueron: infección urinaria y prematurez. El 12.02% de los recién nacidos tuvieron evaluación neurológica neonatal anormal. Los factores de riesgo para evaluación neurológica anormal al nacimiento fueron: peso al nacer menor de 2500 g, bajo peso para la edad gestacional, cesárea urgente y perímetro cefálico menor de 30 cm. CONCLUSIONES: Las características de las embarazadas del Noreste de México han sido poco estudiadas, casi la tercera parte ellas son adolescentes con un nivel importante de pobreza. Existe una relación significativa entre algunas características del parto relacionadas con una evaluación neurológica anormal del recién nacido.

Abstract OBJECTIVE: To determine the characteristics of pregnancy and birth in public hospitals in northeastern Mexico. Analyze the results of the neurological evaluation of newborns MATERIALS AND METHODS: Case series, ambispective, multicenter, randomized, cross-sectional study conducted from 2017 to 2020 in three public hospitals in Nuevo León, Mexico. The sample was recruited from randomly selected puerperium mothers and newborns with Sheridan Perreira's Neo Neuro and Up assessment. RESULTS: Of 75,951 mothers in immediate puerperium, randomly assigned, 4,241 were studied. Eighty-seven percent were residents of Nuevo León and 12.7% were from other states in northeastern Mexico. Thirty-nine.9% had prenatal care in the hospitals where their children were born. Fifty-one percent were born by euthyroid delivery and 27.4% by programmed cesarean section. Of the newborns, 9.6% were preterm. The most frequent pre and perinatal characteristics were urinary tract infection and prematurity. Abnormal neonatal neurological evaluation was observed in 12.02% of the newborns. The risk factors for abnormal neurological evaluation at birth were birth weight less than 2500 g, low weight for gestational age, emergency cesarean section and head circumference less than 30 cm. CONCLUSSIONS: The characteristics of pregnant mothers in northeastern Mexico have been little studied, almost a third of these mothers are adolescents with a significant level of poverty. There is a significant relationship between some characteristics of delivery related to an abnormal neurological evaluation of the newborn.